The stages of labor

First stage: Active labor

Active labor is when things really get rolling. Your contractions become increasingly intense – more frequent, longer, and stronger – and you'll no longer be able to talk through them. Your cervix dilates more quickly, until it's fully dilated at 10 centimeters. (The last part of active labor, when the cervix dilates from 8 to 10 centimeters, is called transition, which is described in the next section.)

Toward the end of active labor your baby may begin to descend, although he might have started to descend earlier or he might not start until the next stage.

As a general rule, once you've had regular, painful contractions (each lasting about 60 seconds) every five minutes for an hour, it's time to call your midwife or doctor and head to the hospital or birth center. Some caregivers prefer a call sooner, so clarify this ahead of time.

In most cases, the contractions become more frequent and eventually happen every two and a half to three minutes, although some women never have them more often than every five minutes, even during transition.

How long active labor lasts

For many women giving birth for the first time, active labor will last between four and eight hours, though for others, it can be even longer or as short as an hour.

The active phase tends to go more quickly if you're getting oxytocin (Pitocin) or have already had a vaginal birth. If you have an epidural or a big baby, it may last longer.

But many of the pain-management and relaxation techniques used in natural childbirth– such as breathing exercises and visualization – can help you during labor, whether or not you're planning to receive medication.

A good labor coach can be a huge help now, too. And you'll probably appreciate lots of gentle encouragement.

It may feel good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction. You should be able to move around the room freely after your caregiver evaluates you, as long as there are no complications.

If you're tired, try sitting in a rocking chair or lying in bed on your left side. This might be a good time to ask your partner for a massage. Or, if you have access to a tub and your water hasn't broken, you can take a warm shower or bath.

Transition

The last part of active labor – when your cervix dilates from 8 to a full 10 centimeters – is called the transition period because it marks the shift to the second stage of labor.

This is the most intense part of labor. Contractions are usually very strong, coming every two and a half to three minutes or so and lasting a minute or more, and you may start shaking and shivering.

By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels. Some women begin to bear down spontaneously – to "push" – and may even start making deep grunting sounds.

There's often a lot of bloody discharge. You may feel nauseated or even vomit now.

Some babies descend earlier and the mom feels the urge to push before she's fully dilated. And other babies don't descend significantly until later, in which case the mom may reach full dilation without feeling any rectal pressure. It's different for every woman and with every birth.

If you've had an epidural, the pressure you'll feel will depend on the type and amount of medication you're getting and how low the baby is in your pelvis. If you'd like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition.

How long transition lasts

Transition can take anywhere from a few minutes to a few hours. It's much more likely to be fast if you've already had a vaginal delivery.

Coping tips

If you're laboring without an epidural, this is when you may begin to lose faith in your ability to handle the pain, so you'll need lots of extra encouragement and support from those around you.

Consider a massage. Some women appreciate light touch (effleurage), some prefer a stronger touch, and others don't want to be touched at all.

Sometimes a change of position provides some relief – for example, if you're feeling a lot of pressure in your lower back, getting on all fours may reduce the discomfort.

A cool cloth on your forehead or a cold pack on your back may feel good, or you may find a warm compress more comforting.

On the other hand, because transition can take all of your concentration, you may want all distractions – music or conversation or even that cool cloth or your partner's loving touch – eliminated.

It may be useful to focus on the fact that those hard contractions are helping your baby make the journey out into the world. Try visualizing her movement down with each contraction.

The good news is that if you've made it this far without medication, you can usually be coached through transition – one contraction at a time – with constant reminders that you're doing a great job and that the your baby's arrival is near.

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